Purpose: To report 3 patients with infective endocarditis who underwent transcatheter arterial embolization for mycotic aneurysm of the distal superior mesenteric artery (SMA). Case Report: Three men (60, 64, and 65 years old) were diagnosed with infective endocarditis. Antibiotics were initiated immediately after admission and continued for several weeks to months. Distal SMA mycotic aneurysm was identified on computed tomography in the vicinity of the ileocolic artery at 33, 26, and 30 days after admission. In case 1, the ileal artery was occluded distal to the aneurysm, with collateral flow to the ileum. In case 2, the mycotic aneurysm was located below the ileocolic artery, which was stenosed distal to the lesion. In case 3, the aneurysm was located on a branch of the ileal artery. Transarterial embolization using microcoils was successfully performed in all patients. No complications associated with embolotherapy or relapse of infection were observed in these 3 patients at 60, 30, and 15 months, respectively. Conclusion: Transcatheter arterial embolization for distal SMA mycotic aneurysm could provide an alternative to open surgery. Anatomical assessment of collateral flow and preprocedure long-term antibiotic therapy could play important roles in preventing bowel ischemia and minimizing the risk of infection relapse.
BaddourLMWilsonWRBayerAS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications. Circulation. 2015;132:1435–1486.
2.
GonzalezISarriaCLopezJ, et al. Symptomatic peripheral mycotic aneurysms due to infective endocarditis. Medicine. 2014;93:42–52.
3.
KordzadchAWatsonJPanayiotopolpusY.Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63:1638–1646.
4.
de TroiaAMottiniFBiasiL, et al. Superior mesenteric artery aneurysm caused by aortic valve endocarditis: the case report and review of literature. Vasc Endovascular Surg. 2016;50:88–93.
5.
TaguchiSTakakuraHHachiyaT, et al. Infectious endocarditis associated with multiple mycotic aneurysms: report of a case. Kyobu Geka. 2006;59:229–233.
6.
SilverSE.Ruptured mycotic aneurysm of the superior mesenteric artery that was due to Cardiobacterium endocarditis. Clin Infect Dis. 1999;29:1573–1574.
7.
TeixeiraPGThompsonEWartmanS, et al. Infective endocarditis associated superior mesenteric artery pseudoaneurysm. Ann Vasc Surg. 2014;28:1563.e1–1563.e5.
8.
SharmaGSemelMEMcGillicuddyEA, et al. Ruptured and unruptured mycotic superior mesenteric artery aneurysms. Ann Vasc Surg. 2014;28:1931.e5–1931.e8.
9.
MuaiharaKMatsumotoKKadonoJ, et al. A surgical case of mycotic aneurysm with Staphylococcus lugdunensis endocarditis. Asian Cardiovasc Thorac Ann. 2017;25:296–299.
10.
SoreliusKWanhainenAFurebringM, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134:1822–1832.
11.
AchilliPGuttadauroABonfantiP, et al. Streptococcus agalactiae infective endocarditis complicated by multiple mycotic hepatic aneurysms and massive splenic infarction: a case report. BMC Gastroenterol. 2017;17:170–174.
12.
TanakaMKohnoTObaraH, et al. Progressive mycotic celiac artery aneurysm associated with coagulase-negative Staphylococcal prosthetic valve endocarditis. Circ J. 2018;82:1965–1967.
13.
RabellinoMGarcia-NielsenLZanderT, et al. Stent-assisted coil embolization of a mycotic renal artery aneurysm by use of a self-expanding neurointerventional stent. Cardiovasc Interv Radiol. 2011;34(suppl 2):S109–S112.
14.
FiskMPeckLFMiyagiMJ, et al. Mycotic aneurysms: a case report, clinical review and novel imaging strategy. QJM. 2012;105:181–188.
15.
DíazELozanoFSGonzálezS, et al. Open and endovascular treatment for pseudoaneurysms of the superior mesenteric artery. Ann Vasc Surg. 2010;24:690.e9–690.e12.
